Copays, work referrals, other measures eyed for Louisiana Medicaid expansion _lowres

Advocate staff photo by TRAVIS SPRADLING -- Gov. John Bel Edwards speaks Tuesday at the State Capitol at a press conference with legislators, community leaders, and key stakeholders, just after issuing his first executive order, No. JBE 16-01, to provide for Medicaid expansion in the state of Louisiana. Dept. of Health and Hospitals Secretary Dr. Rebekah E. Gee, MD, is at right.

John Bel Edwards’ first executive order actually reads kind of like an accusation.

After a day and night of inaugural festivities Monday, Edwards got down to business Tuesday, put his pen to paper and kept his promise to accept federal money to expand Medicaid for 300,000 or more poor Louisianians under President Barack Obama’s Affordable Care Act.

But Edwards did more than that. He spelled out in the official document how much his predecessor, Bobby Jindal, had forfeited on behalf of the cash-strapped state by refusing to do so while he waged a failed bid to become the Republican presidential nominee: a cool $3 billion, according to one of the 11 “whereases” in the order’s text.

And Edwards spent much of the rest of the document zeroing in on just who suffered from Jindal’s actions.

“Access to quality and affordable health care for the working poor is and should be a primary concern to the state of Louisiana,” the order declares. The law allows states to cover adults at or below 138 percent of the federal poverty level, it continues, with the federal government — fueled by tax dollars Louisianians pay whether the money is spent here or elsewhere — picking up most of the tab.

And “most of the people affected by Medicaid expansion are gainfully employed, yet have incomes where it is exceedingly difficult to afford health care coverage,” it notes.

Here’s one thing Edwards left out: By delaying the expansion until now instead of adopting it when the law took effect, Jindal may have cost the state the ability to benefit from the three fully paid years that the health care law allows. Under current law, if the Edwards administration is able to implement expansion as quickly as it intends, the state will be able to tap into only one year of 100 percent reimbursement before the figure drops to 95 percent.

Luckily for Edwards, though, Obama wants to offer states like Louisiana a do-over. The president announced during his visit to Baton Rouge on Thursday that he’ll ask Congress to give states that have refused expansion to date a fresh three years of 100 percent funding. The idea is to encourage other states led by reluctant conservative politicians to reconsider the idea. For Edwards, though, it would amount to an unexpected budgetary break and make up for the opportunity that Jindal so casually ignored — if the GOP-controlled Congress goes along, that is.

By making Medicaid expansion his first order of business, Edwards is not only trying to make up for lost time. He’s also picking the lowest-hanging fruit available to him. Of all the things the new Democratic governor vowed to accomplish during his campaign, Medicaid expansion is, by far, the easiest. For one thing, Edwards didn’t need to go through a Legislature that’s dominated by Republicans and already flexing its independence. And despite Jindal’s obstinance, the idea of expanding coverage to people too poor to qualify for subsidies under the health care law’s separate private exchanges is far from radioactive, even in conservative Louisiana.

When Edwards was in the Legislature, his colleagues rebuffed his attempts to force the state to accept the feds’ offer to pay the full cost at first and up to 90 percent thereafter; this was pretty much a foregone conclusion, given Obama’s unpopularity in the state and Jindal’s possession of the veto pen. But lawmakers did approve a measure allowing private hospitals to pool dollars to put toward the local match of up to 10 percent, which set up Edwards’ move and which should go a long way toward relieving concerns that the proportionally small cost would further cripple the state budget.

That Edwards wouldn’t face much resistance became clear as the gubernatorial campaign took shape. Several major business-oriented groups endorsed the idea and made not just a moral case but also a financial one. And all three of the governor’s Republican opponents suggested they’d be willing to take the money, even as they put a more conservative spin on their own approaches.

There were objections this week, from GOP members of Congress and several interest groups. But they amounted to opponents going on record, rather than putting up a genuine fight.

Edwards shouldn’t get too used to that feeling. His other anti-poverty priorities, including raising the state minimum wage, will face contentious pushback from lawmakers and business groups. And the reality of the state’s fiscal crisis, which the Medicaid money will only begin to alleviate, will threaten every initiative that carries a price tag.

So give the new guy a few days to bask in what’s unquestionably a major achievement and even to enjoy telling Jindal that he told him so.

Scolding is the easy part. Fixing all the other problems Edwards inherited is going to be a much tougher slog.

Stephanie Grace can be contacted at sgrace @theadvocate.com. Follow her on Twitter, @stephgracenola.